Association of triglyceride to high-density lipoprotein cholesterol and low-density lipoprotein to high-density lipoprotein cholesterol ratios with glycemic control in type 2 diabetes mellitus: A cross-sectional study from a Libyan clinical cohort

Poor glycemic control in type 2 diabetes mellitus (T2DM) is frequently associated with adverse lipid profiles, including elevated triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C). Lipid ratios, including TG/HDL-C (triglycerides/high-density lipoprotein cholesterol) and LDL-C/HDL-C (low-density/ high-density lipoprotein cholesterol), may serve as simple markers of insulin resistance and cardiometabolic risk. This study aimed to investigate the association between glycemic control and lipid parameters, including TG, HDL-C, and lipid ratios, in a Libyan cohort of T2DM patients. In this retrospective cross-sectional study, 363 T2DM patients (140 males, 223 females) aged 18 to 80 years attending a diabetic polyclinic in Benghazi between January 2022 and January 2024 were included. Clinical and biochemical data, including fasting lipid profiles and glycated hemoglobin (HbA1c), were extracted from patient records. Participants were classified according to glycemic control (HbA1c < 7% vs ≥7%). Associations between lipid parameters, lipid ratios, and glycemic control were assessed using multivariable logistic regression adjusted for age, sex, BMI, duration of diabetes, and statin use. Patients with uncontrolled HbA1c (≥7%) had significantly higher TG/HDL-C ratios (3.79 ± 2.52 vs 2.92 ± 2.42; P = .007) and LDL-C/HDL-C ratios (2.55 ± 1.30 vs 1.95 ± 1.05; P < .001) compared with those with controlled HbA1c. In multivariable logistic regression analysis, higher low-density lipoprotein cholesterol (LDL-C) levels were significantly associated with uncontrolled HbA1c (OR = 1.02; 95% CI: 1.01-1.03; P < .001). When lipid ratios were evaluated, the LDL-C/HDL-C ratio remained significantly associated with uncontrolled HbA1c (OR = 1.05; 95% CI: 1.02-1.09; P = .003). Lipid ratios, particularly LDL-C/HDL-C, were associated with poor glycemic control in type 2 diabetes mellitus; however, their clinical utility requires further validation in prospective studies. Integrated management of dyslipidemia and glycemic control is essential to reduce cardiovascular complications in this population.